What’s New in Health Care Reform: Nov. 29

Top highlights this week include: Lawmakers making progress in talks on children's health care; insurers claim their costs will rise if states pick essential benefits; as health care changes, insurers, hospitals, and drugstores team up; groups make year-end push to delay Obamacare taxes; and U.S. HIV diagnoses improving.

The Week in Review provides an overview of the past week’s top health care content, including industry news and trends, Mayo Clinic and Mayo Medical Laboratories news, and upcoming events.

Lawmakers Making Progress in Talks on Children’s Health Care

Congressional negotiators are making progress towards a bipartisan deal to reauthorize children’s health insurance and several other important health-care programs, sources say. Staff from the relevant committees in both parties and chambers met over the Thanksgiving break and are getting closer to an agreement, according to lobbyists and aides. Via The Hill.

Heated and Deep-Pocketed Battle Erupts over 340B Drug Discount Program

A 25-year-old federal drug discount program has grown so big and controversial that it faces a fight for survival as federal officials and lawmakers furiously debate the program’s reach. The program, known as 340B, requires pharmaceutical companies to give steep discounts to hospitals and clinics that serve high volumes of low-income patients. The Centers for Medicare and Medicaid Services struck a blow to the program this month announcing a final rule to cut Medicare payments for hospitals enrolled in the program by 28%, or about $1.6 billion. Via Kaiser Health News.

Insurers Claim Their Costs Will Rise if States Pick Essential Benefits

Health insurers fear they will be on the hook for greater health care costs if the CMS finalizes its proposal to allow states to define their own essential health benefits starting in 2019. In comments to the CMS, insurance companies that sell plans on the individual and small groups markets also said that giving states the ability to update their benchmark plans annually would confuse consumers and undermine the markets’ stability. Via Modern Healthcare.

As Health Care Changes, Insurers, Hospitals, and Drugstores Team up

They seem like odd couples: Aetna, one of the nation’s largest health insurers, is in talks to combine with CVS Health, which manages pharmacy benefits. The Cleveland Clinic, a highly regarded health system, joined forces with an insurance start-up, Oscar Health, to offer individuals a health plan in Ohio. Aetna also has new partnerships with large health systems that include hospitals and doctors’ groups in Northern California and Virginia. These established players are venturing beyond their traditional lines of business, now that federal officials have quashed the mega-mergers proposed by the biggest insurers and blocked a deal between two large drugstore chains. Via NY Times.

Groups Make Year-End Push to Delay Obamacare Taxes

Industry groups are gearing up for a final push to repeal or delay taxes in Obamacare before the end of the year. Stalling the taxes on medical devices and health insurance, which were included in the health law to help pay for its coverage expansion, has been a rare area of some bipartisan cooperation on Obamacare. There are members of both parties who oppose the taxes and have previously come together to push them off. But the previous delays are running out on January 1. With the taxes looming, health insurers, medical device companies, and others are pushing to make sure they aren’t hit. Via The Hill.

For Thousands of Minnesota Patients, Medicaid Will Have a New Look

Minnesota’s biggest public health insurance program will take on a new shape after next year, when about 500,000 enrollees will be encouraged to develop a close relationship with a primary care clinic, while doctors, clinics, and HMOs will be held more accountable for patient care outcomes. The broad outlines of the concept, which would take effect for Medicaid patients in the metro area in 2019, were released last week by the Minnesota Department of Human Services. They continue a set of reforms designed to raise quality and cut costs in Medicaid. But they also could shake up the Medicaid market for thousands of people because hospital and clinic systems will have the option of serving patients directly without using an HMO as an intermediary. Via Star Tribune.

U.S. HIV Diagnoses Improving, But Progress Varies

Delays in the time between becoming infected with HIV and getting a diagnosis are shortening, helped by efforts to increase testing for the virus that causes AIDS, U.S. health officials said. The report, released by the Centers for Disease Control and Prevention, found that 50% of the 39,720 people diagnosed with HIV in 2015 had been infected for at least three years, a seven-month improvement compared with 2011. Via Reuters.

Providers Unsure That CMS “Meaningful Measures” Will Reduce Burden

A month after CMS Administrator Seema Verma announced the new “meaningful measures” quality reporting framework as a way to ease physicians’ regulatory burden, providers remained confused about the initiative’s goals. Rather than replacing existing quality reporting programs, meaningful measures will be applied to them, so the CMS can make sure those measures align with the CMS’ core tenets of quality reporting, said Dr. Pierre Yong, director of the CMS’ quality measurement and value-based incentives group. Via Modern Healthcare.

In Trump Health Secretary Pick, Dems Have Questions but Hope

President Donald Trump’s pick for health secretary is a former pharmaceutical company executive who already has drawn heat from Democrats over his ties to the pharmaceutical industry. But as Alex Azar faces his first nomination hearing, even some of those critics see signs he could shift the health care debate away from partisan confrontation. Via AP.

Next U.S. Restructuring Epidemic: Sick Health-Care Companies

A growing number of health care companies may face near-death experiences of their own. A wave of hospitals and other medical companies are likely to restructure their debt or file for bankruptcy in the coming year, following the recent spate of failing retailers and energy drillers, according to restructuring professionals. Regulatory changes, technological advances, and the rise of urgent-care centers have created a “perfect storm” for health care companies, said David Neier, a partner in the New York office of law firm Winston & Strawn LLC. Via Bloomberg.

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